Ed’s corner of the web

At long last, all of our Vietnam photos are uploaded here.  It was a great trip, and we had an especially great time exploring all of the culinary variety of the country.  The Vietnamese are serious about food, and it was an adventure finding all the favorite local spots to eat.  We had great success using online blogs and personal travel pages to target our searches, and we found this strategy to be much more fruitful than using guidebooks, which usually cater to slightly different palates.  The “find the sketchiest-looking place that’s full of Vietnamese people” strategy also worked exceedingly well.  Other highlights included whizzing around on motorbikes in the countryside around Hue, getting lost in the frenetic markets, and experiencing the near-worship of Uncle Ho.

Throughout the trip, I found myself having a hard time capturing the country in pictures.  For one thing, large parts of the country aren’t objectively pretty – lots of urban landscapes, traffic, crowds, pollution.  But I felt it went beyond that; I was taking pictures of some of these not-so-pretty things because they appealed to me on some level.  The photographic result failed to capture that appeal; places seemed bland and lifeless when they were anything but.  Only looking back over the photos after the fact did I realize what the problem was.  You use all your senses to experience Vietnam.  You smell it, you feel it, you hear it, you taste it.  My photos failed because they only had one sense to exploit when all five were necessary.  You have to smell the fish market of Hoi An to really experience it.  You have to feel the quiet misty air and cool water of Ha Long Bay, hear the cacophony of motorbike traffic whizzing around you in Saigon.  And by god you have to taste the tamarind crab – not to be missed.  Perhaps truly great photographers are able to somehow capture more that what the eye sees.  I’m not there yet.  But I’ll keep on trying.  In the meantime, enjoy these pale, washed-out reflections of a vivid, vibrant country.

Obligatory shot with the Lunch Lady of Saigon. This is a badge of honor for Vietnamese foodies.

As if I needed something else to suck up my time.  I’ve been inspired by the fabulous idea pictured here.  I kind of like the idea of using my own slides instead of buying used, so this gives me an excuse to dust off the old film camera and take lots more pictures.  I figure you could even create a sort of photomosaic if you weren’t after anything too high resolution.  Now to find some cheap slide film…

The NEJM had an interesting study this month on managing health care expenditures.  The prevailing wisdom has been that cost-sharing (making people more reponsible for the cost of their care) reduces expenditures while not harming health in the general population.  This study looked at a population of Medicare recipients and found otherwise.

When you raise the copays for Medicare enrollees, you end up making a little more money off of copays, and you reduce the total number outpatient visits.  This saves Medicare money.  This is good.  Unfortunately, you also increase the number of hospital admissions and the length of those admissions, with the end result being that you spend much more money than you save or bring in.  This is bad.

This is a prime example of why studies like this are crucial when deciding how to spend healthcare dollars.  The interplay of economics, health, and human behavior are so complex that there’s no predicting which way an intervention will take you.  Great study.

Some people go crazy with Christmas decorations, a rare few do both Thanksgiving and Christmas, but it’s only the very elite hard core decorator who goes for the end-of-year trifecta of Halloween, Thanksgiving, and Christmas.  Our across-the-street neighbor is one of these people.  Behold:

The picture can’t really do it justice.  The skeleton inside the glowing coffin on the first floor moves around.  The dude on the organ at the far right plays scary music.  And there are speakers that play all manner of screams, cat yowls, and other scary sounds.

My favorite costume of the night: a family of three little girls, the middle one dressed up as Dorothy, ruby slippers and all.  The little one was the cowardly lion, which was very practical since it looked very fleecy and warm.  The eldest (maybe about 4 years old) was dressed as the wicked witch, and she had ruby slippers, too.  Clearly she was the Wicked Witch of the East, pre-house-crushing.

Carisa’s favorite costume of the night: three little girls, maybe about 6 years old, dressed up in ripped up cheerleader costumes covered in blood.  Yeah.

So there I was, drowning in comment spam, my poor little blog neglected out of an ill-informed, futile attempt to reduce the tide of spam coming from all the pharmacies of ill-repute out on the interwebs.  Desperate, I turned to my colleague Eliot Gelwan for help.  A prolific blogger himself, I knew I could turn to him for advice.  I was not disappointed, for Dr. Gelwan pointed me in the direction of WordPress’s own anti-spam plugin, a feature I had not noticed in my helplessness and n00bishness.  Now girded in the armor of Akismet, I feel rejuvenated.  I no longer have to login to my blog in fear.

My little corner of the pediatric world seems to be rather occupied of late with a recent study published in the BMJ.  The study looked at a group of 240 kids in the Netherlands who were given either amoxicillin (an antibiotic) or placebo for treatment of otitis media (ear infection).  Looking back 3.5 years later, the researchers discovered that those kids who were randomized to receive amoxicillin had a 2.5 times higher risk of recurrent ear infection.

The trend in recent years has been for less and less antibiotic treatment of ear infection, opting instead for a “wait and see” approach for uncomplicated cases.  This has been a reflection of data that shows that most ear infections are caused by viruses (not helped by antibiotics), and that it doesn’t seem to make much difference whether one treats simple ear infections with antibiotics or not.

So you would think that docs would be receptive to this additional data further reinforcing the lack of need for antibiotics in many, if not most, ear infections.  You would think that, but you would be wrong.  Pediatricians and family medicine physicians have spent a lot of time on the intertubes resisting reduction of their antibiotic usage in ear infections, citing personal experience and anecdotal evidence (“back in my day…”) while giving wild exhortations in CAPITAL LETTERS.

The one thing that these docs don’t use to make their point is data – real data.  By that I mean large, randomized, well-controlled studies that seek to eliminate confounding variables and answer a specific clinical question.  At what point does personal experience become real data?  Never.  How long does one have to practice before their anecdotes become a valid basis for policy?  Let’s just say longer than anyone is willing to wait.

I pause here to realize that even doctors, for all their education, for all the trust placed in them by their patients, are just as prone as anyone to having “blind spots” – areas of thought that refuse to accept evidence contrary to their beliefs.  For some doctors, it’s vaccines and autism.  For others it’s herbal medicine.  For these docs, it just happens to be antibiotics and ear infections.

So what will it take to shed enough light on the issue to get these docs to change?  A large part of it, I think, is getting people to take their blinders off.  But this, unfortunately, is something you can’t do for them.  It’s not easy to self-criticize, but I firmly believe that opening your own practice and knowledge to critique can only help you become  more knowledgeable, more humble, and a better doctor.  Failing to do so might preserve a frail ego, but it does disservice to everyone else.

This is just too cool for words…

The hard drive on my laptop met an untimely end about three weeks ago.  There were no warning signs, no ominous clicks.  Instead, the machine refused to finish booting into Windows one day.  I tried rebooting a few times, and each time the machine would get less and less far into the booting process.  Not good.  I chilled the drive and tried getting into safe mode, which only was stable for about 15 seconds.  Still not good.  Finally I got into a command prompt and got all my data out on a thumb drive.  Whew!

The real circus began when I called up Lenovo support.  Ostensibly it’s in Atlanta, Georgia, but I ran into just as many hard-to-decipher accents as I do when I call tech support in Mumbai.  But that was just the beginning.  Turns out my warranty had expired a mere six days earlier.  I shook my little fist at Shiva and was transferred to warranty sales, where I was offered a $149 extended warranty.  It was more than I would have liked, but I bit, figuring that purchasing a new hard drive and going through the reinstall process would be at least as costly in terms of time and money.

The warranty dude said that I should be able to use my warranty to get service on my laptop in 24 hours.  I called back the next day, only to find that the warranty wasn’t invoiced yet.  I had been misinformed, the new rep told me; warranties don’t invoice for 2-3 business days.  I called back again 4 business days later – still no dice.  This time I was told that it takes 10-14 business days for a warranty to become active.  Flustered, I requested that the extended warranty be canceled.  I couldn’t wait that long to get service on my laptop.  The rep apologized and said that he would expedite the warranty invoice process so I could get warranty service within 2 business days.  I hesitated (why couldn’t they have done this in the first place?!?) but eventually said ok, asking for some sort of email confirmation of the warranty being ready.  Of course, I never got that email confirmation.  I called back a few days later, thoroughly peeved, ready to cancel my warranty order for sure this time.  Guess what?  My warranty order had been canceled already, back at the time of my last phone call!  Gah!  It’s enough to make a guy go Mac…

So after a couple purchases at Newegg and an afternoon of installing software, I’m back to blogging on my laptop.  I’ve got a blacklog of stuff I wanted to write about but probably won’t have a chance to get to.  Fortunately, one topic has continued to be current enough for me to comment on: the “birther” movement.

Unfortunately, you’ve probably heard about these yahoos already.  The internet allows for the creation of an infinite number of echo chambers in which fringe lunatics can congregate and convince themselves that their ideas aren’t pure drivel.  The internet also allows for easy dissemination of these ideas, with the end result being that whackjob claims that would’ve been completely unheard in the pre-information age now have the capability of amassing a larger audience.  The birther crowd – those who believe that Barack Obama was born in Kenya and thus not qualified to be president – is just one sad, deluded poster child of this trend.

Two weeks ago I listened in on an NPR show in which Tom Ashbrook, the moderator, tried to host a discussion with Orly Taitz, one of the leaders of the birther movement.  I’m not the biggest fan of Tom Ashbrook’s style, but if anything he’s a very capable, experienced moderator.  I don’t think I ever heard Tom Ashbrook as not-in-control as he was that night.  Since Tom typically has very reasonable, intelligent people on his show, I think he may have made the mistake of assuming that his usual conversation-control tools would work on Taitz.  Then again, I don’t think anything short of a Tazer and injectable tranquilizers would have worked on Taitz that day.  Her careening, shrieking, disjointed commentary made my brain hurt, and any shred of credibility I might have afforded her (admittedly, not much to begin with) vanished instantly.

People like Taitz don’t go away, though.  And now, with the release of an image of a document purported to be Barack Obama’s Kenyan birth certificate, she continues to dig a deeper hole for herself.  This (pretty clear forgery) is now the smoking gun, the unassailable proof that Obama is the centerpiece of a vast left-wing, Communist, Zionist conspiracy designed to take over the world.  I’ll let snarkier minds lay out the details for you.

I could despair that such a ridiculous issue has wasted so much time and energy, that such rabid lunatics can steal the nation’s attention for such a long time.  And I do, admittedly – just  a little bit.  But outwardly, at least, I’m laughing.  I’m laughing in mockery of the stupidity, close-mindedness, and downright lunacy of these whackjobs.  I can at least get a little entertainment out of them.

It’s been one heck of a month.  Turkey was great – more to follow – but I already feel like I need another vacation.  Too much work, too much long-distance driving, a GI bug, a ten-day course of Tamiflu for an H1N1 exposure, and a death in the family on top of all of that.  I’m beat.

But then two of my readers tell me personally (the other three couldn’t be bothered, I guess) that they noticed I hadn’t updated in a while, so here I am, dragging myself back in front of the keyboard.  Must…post…

Actually, today’s subject of posting is too interesting to pass up.  I hold a special place in my heart for Zicam.  It’s the non-homeopathic homeopathic remedy.  Unlike “conventional” homeopathic remedies, which are diluted so much that you’d be lucky to get a single molecule of active ingredient in a dose, Zicam actually contains biologically active amounts of zinc.  The product manages to squeak by FDA regulation, though, because the product makers finagled a “homeopathic” designation.  (More on this subject from Steven Novella here.)  As if it wasn’t enough to have homeopathic remedies masquerading as medicine, now you have not-so-homeopathic remedies masquerading as masquerade medicine.  All yours for the low low price of $10.  Oh how far we’ve fallen.

Now, as you’ve probably heard, the FDA put the kibosh down on Zicam today.  Seems it could make you lose your sense of smell, permanently.  Not good.  Can you smell what Matrixx Initiatives (the two “x”‘s mean they’re extra extra cool) is cooking next?

You guessed it!  Denial!  Matrixx asserts that, “There is no reliable scientific evidence that Zicam causes anosmia.”  In other words, “We didn’t want to have to do that science stuff to prove safety or efficacy when we brought this junk to market, but we demand that you peform rigorous science-y experiments to take us down.  Neener neener.”  How’s that for a double standard?  In all seriousness, this sort of post-market surveillance for adverse events is the FDA’s job.  If they suspect that there are unreported side effects or adverse events cropping up, then their responsibility is to consumer safety first.

Am I passing early judgment on this?  Yes.  I’d be lying if I denied it.  All the data should be laid out on the table, and Zicam should be given the chance to make its case.  But I’d also be lying if I said I wasn’t getting a great deal of schadenfreude out of today’s news.  It’s very satisfying when a company that tries to get by on disingenuous practices finally gets its comeuppance.

Another speed post from Turkey – this time from the super-cute town of ??rince.  I´m using a Turkish keyboard with some extra characters (stuff like ?, ?, Ü, é, and €) and alternate key placements (ö instead of a comma, ç ?nstead of a period), so typing is a bit of a challenge.  I´ve even got a secondary Alt key to handle the extra stuff.  I´m not even sure this is go?ng to display anyth?ng but gibberish, but I thought it would be a fun experiment to try out.